Pharmacotherapy for Epilepsy & Migraine

Question 1

Migrane Meds (7 &10)

Answer 1

Sumatriptan (imitrex, onzetra xsail, tosymra, zembrace, symtouch),
Naratriptan (amerge), Rizatriptan (maxalt), Zolmitriptan (zomig),
Almotriptan, Froratriptan (frova), electriptan (relpax)

Question 2

Migrane meds MOA:

Answer 2

causes vasoconstriction by binding to 1B/D serotonin on cerebral blood vessels

Question 3

Migraine meds SE:

Answer 3

mild pain, tingling, numbness, coldness or burning sensation at site of injection, fatigue, dizziness, weakness

Question 4

Migraine meds EDUCATION:

Answer 4

take med as soon as symptoms start
AVOID triggers, lights as necessary
stay hydrated, well rested & NOT hungry

Question 5

Calcium Channel Blockers (CCB) meds (1)

Answer 5

Levetiracetam (Keppra)

go to med, good effect on pts

Question 6

CCB MOA:

keppra

Answer 6

blocks action potential in excited neurons

Question 7

CCB INDICATIONS:

keppra

Answer 7

generalized or partial seizures

Question 8

CCB CONTRAINDICATIONS:

levetiracetam

Answer 8

pregnancy/breastfeeding

Question 9

CCB SE/ADRs:

levetiracetam

Answer 9

suicidal thoughts, hepatitis / SJS, Toxic epidermal necrolysis

Question 10

CCB Nursing Considerations:

Answer 10

• pt should be adcised to take meds as directed & that doses should be evenly spaced throughout the day.
• **phenytoin - monitor serum levels **
• may take several wks to obtain desired med effect
• abrupt withdrawal of med may cause STATUS EPILEPTICUS - seizure lasting >20 mins
• Pts. should AVOID alcohol & other CNS depressants
• Nothing should be in pts. mouth & DONT restrain => put them on their side wait 5 mins & if more then call 911!
• after pts have a stroke, seizure is very likely to happen have precautions

Question 11

Sodium Channel Blockers

SCB Meds (6)

Answer 11

• Phenytoin (dilantin)
• Fosphenytoin (cerebyx)
• Carbamazepine (tegretol)
• Valproic Acid (depacon)
• Sodium Valproate (depakote)
• Lamotrigine (lamictal)

Question 12

SCB Overall Education

Answer 12

• Type, frequency, and duration of seizures; have a log and doc/indicate
• Screenings
  Depression, suicidal thoughts
  Pregnancy
• Laboratory test results
  CBC* leukopenia
  Liver and renal function tests
• Dx tests
  ECG (phenytoin, carbamazepine, or lamotrigine)

Question 13

SCB MOA & Indication

Answer 13

• blocks the action potential in the neuron
• Partial seizures, generalized seizures

Question 14

SCB CI

Answer 14

• Pregnancy/breastfeeding
• Severe Hepatic Disease

Question 15

Phenytoin, fosphenythoin
SE & ADR

PO & IV

Answer 15

• Headaches, dizziness, visual disturbances, hypersensitivity reactions (SJS, TEN, DRESS), hepatotoxicity, impaired metabolism of vitamin D, decreased absorption of folic acid and vitamin B12, suicidal thoughts
• Boxed warning:rapid IV administration can result in hypotension and cardiac arrhythmias

Question 16

Phenytoin nursing edu

Answer 16

Recognize signs of gingival hyperplasia; e.g., sore, swollen gums
Maintain dental hygiene,
Monitor ECG

Question 17

Carbamazepine: (SE/ADR)

Answer 17

Pancreatitis, hepatotoxicity, renal dysfunction, hypertension, AV block
Boxed warning:Steven Johnson Syndrome, Toxic epidermal necrolysis, Drug Rash with Eosinophilia and Systemic Symptoms, bone marrow depression

Question 18

Carbamazepine CI:

Answer 18

Avoid grapefruit/ grapefruit juice

Question 19

Lamotrigine SE & ADR

Answer 19

Headache, dizziness, dysmenorrhea; seizures, suicidal thoughts, disseminated intravascular coagulation, leukopenia, thrombocytopenia
Boxed warning:SJS, Toxic epidermal necrolysis

Question 20

Valproate SE & ADR

Answer 20

Gastrointestinal problems, thrombocytopenia, leukopenia , suicidal thoughts, CNS depression,
Boxed warning:pancreatitis, hepatotoxicity, fetal toxicity, DRESS

Question 21

Valproate Education

Answer 21

Report symptoms of pancreatitis; uppper abd pain, N/V, anorexia